An Uncommon Cause of Dyspnea: Right‐Sided Morgagni Hernia in a 70‐Year‐Old Female

ABSTRACT

We report a case of right‐sided Morgagni hernia in an elderly female. Morgagni hernia is a rare congenital defect. In elderly patients, symptoms like recurrent infections, dyspnea, or abdominal pain necessitate urgent evaluation. Treatment involves surgical repair, which provides full symptomatic relief with low recurrence rates, ensuring a positive long‐term prognosis.

A Morgagni hernia is characterised by the failure of the pars tendinalis of the costochondral arches to fuse with the pars sternalis. This anatomical deficiency, which occurs on the right side in approximately 90% of cases, allows for the herniation of abdominal contents—most frequently the large intestine or omentum—into the thoracic cavity.

A 70‐year‐old female presented in Pulmonology clinic for general anaesthesia fitness for cholecystectomy. On history she revealed to have epigastric pain and right‐sided chest pain for 6 months associated with dry cough and dyspnea (mMRC Grade 2). There was no history of fever, hemoptysis, or weight loss. She was normotensive, normoglycemic, and a non‐smoker. There was a history of biomass exposure. On examination, she was conscious and oriented, with only the finding of right hypochondrium tenderness. On examination, there was decreased air entry on the right side of the chest. Spirometry was performed, which was normal. CXR showed right‐sided hemidiaphragm (Figure 1). CT chest showed a 61 × 4.6 mm defect in anterior aspect of diaphragm along the cardiophrenic angle through which omental fat and bowel loops are seen herniating into the thoracic cavity consistent with morgagni hernia without any evidence of obstruction and inflammatory changes. The herniated contents are seen abutting the right heart border with mild mass effect on adjacent lung parenchyma (Figure 1b–d). Patient was referred back to the surgery department for the surgical management.

FIGURE 1.

(a) Chest X‐Ray PA view showing radio‐opacity in right lower lung field making fluid levels. (b) CT chest coronal view showing well‐defined fluid density in right lower lung field with subsegmental collapse of adjacent lung. (c) CT Chest (Sagittal)—lower arrow points to a large hernial defect in the diaphragm, and the upper arrow identifies abdominal contents—specifically herniated bowel loops and omentum—translocating superiorly into the thoracic cavity. (d) CT Chest (Sagittal)—defect at the level of foramen of Morgagni showing omental loops herniating in right thoracic cavity.

A Morgagni hernia is characterised by the failure of the pars tendinalis of the costochondral arches to fuse with the pars sternalis. This anatomical deficiency, which occurs on the right side in approximately 90% of cases, allows for the herniation of abdominal contents—most frequently the large intestine or omentum—into the thoracic cavity. While often identified incidentally in adulthood, the clinical presence of concurrent gastrointestinal and cardiorespiratory symptoms may indicate its existence [1].

Due to a 10% risk of severe complications such as bowel obstruction, volvulus, or necrosis, surgical intervention is indicated even for asymptomatic patients. Although standardised repair guidelines are currently absent, the laparoscopic approach is generally preferred over open techniques due to its superior safety profile and reduced duration of hospitalisation. However, clinicians must remain vigilant regarding postoperative outcomes, as recurrence rates documented in specialised literature range significantly from 2% to 42% [1, 2].

Author Contributions

Ali Gohar: conceptualisation, writing – original draft, writing – review and editing, visualisation. Asma Farooq: investigation, validation, review. Memoona Anees: validation, review, writing – original draft. Muhammad Zumar Asif: investigation, data curation, visualisation. Muhammad Husnain Ahmad: methodology, writing – review and editing.

Funding

The authors have nothing to report.

Disclosure

No AI assisted technology used.

Ethics Statement

IRB approval was not required for this article. The authors declare that this study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent

The authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images and attest that the form used to obtain consent from the patient complies with the Journal requirements as outlined in the author guidelines. All imaging data (CT, MRI, PET/CT) included in this report have been anonymised to protect the patient's identity. No personal identifiers, such as names, dates of birth, or facial features, are included.

Conflicts of Interest

The authors declare no conflicts of interest.

Ahmad M. H., Gohar A., Farooq A., Anees M., and Asif M. Z., “An Uncommon Cause of Dyspnea: Right‐Sided Morgagni Hernia in a 70‐Year‐Old Female,” Respirology Case Reports 14, no. 7 (2026): e70660, 10.1002/rcr2.70660.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.